Walter Edwin Koppenbrink III, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

11324 Issued in AZ

Practice address

4350 E Camelback Rd
Suite F100
Phoenix, AZ 85018-2701

Phone

(602) 955-8700

Fax

(602) 553-8142

NPI assigned

Apr 21, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/1482/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Practice Specialists LTD.

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1972563187
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422316800000",
    "number": "1982660726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4350 E CAMELBACK RD",
            "address_2": "SUITE F100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850182701",
            "telephone_number": "602-955-8700",
            "fax_number": "602-553-8142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4350 E CAMELBACK RD",
            "address_2": "SUITE F100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850182701",
            "telephone_number": "602-955-8700",
            "fax_number": "602-553-8142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPPENBRINK",
        "first_name": "WALTER",
        "middle_name": "EDWIN",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2015-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "11324",
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AZ",
            "license": "11324",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Howard Kootman, DMD
• David Vincent Kop, DDS
• Cheyenna Lynne Kopacz, DNP FNP-C
• Tammy Kopelman, MD
• Jessica Kopesky, COTA/L
• Sarah Koppenhoefer-Little, OTR/L
• Sameet Koppikar, DDS
• Zackery Kopping, DC
• Shailaja Devi Koppolu, M.D.
• Sampunarao Koppula, M.D.

• Internal Medicine Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Internal Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.